sutures newsletter


P & T Approvals, FDA Warning About Hepatitis Drugs, Statement About Plavix

Pharmacy Focus

See highlights of the October meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has released a warning regarding the risk of serious liver injury with use of hepatitis treatments Viekira Pak and Technivie, and the agency says long-term use of Plavix does not change the risk of death for patients with heart disease.

Mark Your Calendar

Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Education Schedule

Click the PDF links below to see the Department of Surgery's education schedule.

Education Schedule - December 2015 (PDF)  

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

Surgeon Scorecard: How Patients Choose a Physician

By Timothy J. Daskivich, MD, MSHPM
Staff Physician, Urology Academic Practice
Urologic Oncologist, Samuel Oschin Comprehensive Cancer Institute
Director, Health Services Research, Department of Surgery

The wide variation in the quality of healthcare provided by physicians in the United States has prompted a call for more transparent reporting of individual physician performance to help consumers identify high quality providers. The medical community at large has been slow to respond, ostensibly due to concerns about accuracy and fairness of comparisons but also due to uncertainty about impact on the profession.

As a result of this delay, consumer groups have developed online tools to satisfy the public's need for more information, and these tools are being used. In September 2012, a survey of 2,137 U.S. adults found that 65 percent were aware of physician ratings websites and that 59 percent reported these sites to be "somewhat important" or "very important" in choosing a physician.

ProPublica, a nonprofit corporation that calls itself a "newsroom that produces investigative journalism in the public interest," recently launched a provocative project to compare quality of individual surgeons using Medicare claims data called the Surgeon Scorecard. This tool provides a user-friendly interface to compare individual surgeons (and institutions) by surgical volume and complication rates — a composite measure of surgery-specific complications, 30-day readmissions and in-hospital mortality — across eight of the most common surgical procedures performed in the U.S.

In addition, it shows how individual surgeons compare to others locally and nationally, plotting them across a spectrum of low, medium and high rates of complications, which are risk-adjusted for age, sex, health status and condition-specific variables. To the healthcare consumer seeking a high-quality surgeon, this tool is a huge step forward, providing objective comparisons of performance where there was previously a vacuum of information.

Despite its merits, there are still many flaws in the Surgeon Scorecard: the difficulties of making robust comparisons of surgeons based on rare events, the questionable validity of using Medicare claims to identify these events, the inability to completely adjust for case mix. These are important concerns that need to be addressed, especially since unsuspecting consumers will assume that comparisons are fair and unbiased.

But aside from these details, there are even bigger questions: How do we prevent surgeons from "cherry-picking" easier cases to optimize outcomes? How do we prevent those who care for the sickest patients from being unduly penalized? How do young surgeons without a track record develop in this environment? If market forces concentrate care in the hands of a few highly skilled providers, will this ultimately result in reduced access to care?

However, for all of these growing pains, it would be a mistake for the surgical community to react defensively to the concept of transparency, since this is undoubtedly the future of how patients will select a surgeon in the era of big data. Instead, we need to fully embrace transparency and accountability, and we should focus on ways to improve our quality of care to prepare for this eventuality.

One way is to use Crimson data to understand your own strengths and weaknesses in terms of key quality outcomes. This powerful resource available to all surgeons at Cedars-Sinai summarizes your individual performance on numerous quality indicators and shows how you compare to your peers nationally and locally.

Another way to understand and improve the quality of care that you provide is to participate in a quality collaborative; these collaboratives collect data and provide feedback to their members about performance in areas of quality, cost and efficiency of care, and they work together to address areas of deficiency. As the director of Health Services Research for the Department of Surgery, I hope to form such a quality collaborative across the surgical subspecialties at Cedars-Sinai over the coming months. By working together on continual self-assessment and meaningful quality improvement, we can ready ourselves for the time, in the not-too-distant future, when all data is public.

Timothy J. Daskivich, MD, MSHPM, is a urologic oncologist in the Academic Urology Program and the director of Health Services Research for the Cedars-Sinai Department of Surgery. His clinical practice includes surgical treatment of cancers of the prostate, kidney, bladder and testis, with a focus on prostate cancer. He balances his clinical practice with a passion for health services research, a topic that addresses cost, quality and efficiency of healthcare. His main research focus is on life expectancy and its role in treatment decision-making for men with early-stage prostate cancer. His work promotes a more personalized approach to care to reduce unnecessary overtreatment, while targeting treatment to those who need it. He has published in Annals of Internal Medicine, Cancer, Archives of Internal Medicine and the Journal of Urology. His nationally recognized work has received funding from the American Cancer Society and the American Urological Association.